At an appointment at the pediatrician’s office, a patient’s mother states, “My son gets rough with some of the neighborhood kids. I am worried that he is becoming a bully.” Which statements by the mother need more teaching? Select all that apply

When my son becomes aggressive, I feel he needs to be punished.

I think it is good for him to bond with his dad, so they often watch TV together.

I am trying to get him to learn to say what he is upset about in words.

Boys will be boys, so I think this can be considered a normal stage in development.

I am thinking that a time-out would be a better strategy than spanking when my son shows this behavior.

Answer and Explanation

Correct Answer : A,B,D

Aggressive behaviors in preschoolers are quite common and often developmentally typical, though they can be distressing for caregivers. These behaviors usually stem from limited emotional regulation, impulse control, and communication skills. These behaviors in preschoolers require supportive, developmentally appropriate interventions that teach emotional regulation, not harsh discipline or normalization of harmful behavior.

Rationale for correct answers:

1. The idea that aggressive behavior must be punished reflects a misunderstanding of effective behavior management. Punishment often increases fear or resentment without teaching appropriate alternatives. Positive discipline strategies, like time-outs, redirection, and emotional coaching, are more effective in helping children learn self-control.

2. While bonding with a parent is beneficial, passive screen time, especially involving violent or aggressive content, has been linked to increased aggression in children. Watching TV together without discussing content or modeling healthy behavior may reinforce negative actions.

4. Saying “boys will be boys” minimizes and normalizes aggression, which discourages healthy behavior correction. Aggression is not an acceptable or inevitable stage of development. Children need to be taught empathy, communication, and boundaries.

Rationale for incorrect answers:

3. Teaching a preschooler to express feelings in words rather than through physical actions helps build emotional intelligence and social skills. This statement reflects a developmentally appropriate strategy.

5. Time-outs are a recommended discipline technique for preschoolers. They provide a cooling-off period and are more constructive than spanking, which can lead to increased aggression and emotional harm.

Take home points

Preschool aggression should be addressed through positive behavior strategies, not punishment or minimization.
Parental modeling, including screen content and reactions to conflict, strongly influences child behavior.
Statements like “boys will be boys” can undermine the importance of teaching empathy and respectful behavior.
Encourage emotional expression, clear boundaries, and age-appropriate consequences like time-outs or loss of privileges.

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Correct Answer is C

Explanation

Visual acuity refers to the clarity or sharpness of vision. Visual acuity improves with age, reaching 20/20 by approximately age 6–7. Early detection of vision problems is important to prevent conditions like amblyopia, which can be treated more effectively when caught early.

Rationale for correct answer:
3. At age 4, 20/40 vision is developmentally normal. This means the child can see at 20 feet what a person with perfect vision sees at 40 feet. It reflects typical visual development at this age.

Rationale for incorrect answers:

1. 10/10 is not a standard measurement in vision testing and is not used clinically in the U.S.

2. 20/20 vision is ideal but not expected for most 4-year-olds. While some may achieve it, it is more typical for older children, around 6 years and above.

4. 40/40 is not a valid or recognized measure of visual acuity. Standard measurements use 20 as the baseline.

Take home points

20/40 is normal visual acuity for a 4-year-old, with gradual improvement expected as the child grows.
Routine vision screening begins in the preschool years to identify early issues.
Nurses should recognize age-based norms to properly evaluate developmental progress and guide parental expectations.
Referral is needed if visual acuity is worse than age norms or if there's evidence of strabismus or other visual concerns.

A. Trying to get sympathy from the nurse. B. Exhibiting an example of magical thinking. C. Making up stories to entertain the nurse. D. Expressing remorse for having yelled at her sister.

Correct Answer is B

Explanation

Preschoolers are in Piaget’s preoperational stage, where magical thinking is prominent. They believe that their thoughts, wishes, or behaviors can cause real-world events, even illness or injury, because they cannot yet separate cause from coincidence.

Rationale for correct answer:

2. Magical thinking is a normal cognitive feature of preschool-aged children. They may believe that bad behavior causes bad outcomes, like getting sick. This stems from limited understanding of causality and can lead to feelings of guilt. Nurses must correct these misconceptions gently and provide reassurance.

Rationale for incorrect answers:

1. Preschoolers may seek comfort when ill, but this statement is not a form of manipulation or sympathy-seeking. It reflects a sincere belief shaped by their developmental stage.

3. While preschoolers enjoy imaginative stories, this comment is not a playful fabrication, it reveals a misunderstanding of illness due to magical thinking.

4. Though the child may feel some regret, the belief that being “bad” caused the illness goes beyond simple remorse. It is an example of flawed logic rather than true emotional processing.

Take home points

Magical thinking in preschoolers can lead them to believe their thoughts or actions cause illness or misfortune.
Nurses should provide age-appropriate explanations and reassure the child that illness is not a punishment for behavior.
Understanding developmental psychology helps nurses address emotional needs as well as physical ones.
Encouraging open conversation and correcting misunderstandings fosters emotional resilience and trust in healthcare settings.

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At an appointment at the pediatrician’s office, a patient’s mother states, “My son gets rough with some of the neighborhood kids. I am worried that he is becoming a bully.” Which statements by the mother need more teaching? Select all that apply

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Naxlex Comprehensive Predictor Exams

Which result should a nurse expect if a 4-year-old child’s visual acuity test is normal for the child’s developmental age?

Correct Answer is C

Explanation

A 4-year-old child, who is hospitalized with pneumonia, tells the nurse, “I got sick because I was bad. I yelled at my little sister yesterday.” The nurse determines that which of the following is an accurate explanation for the child’s comment? The child is:

Correct Answer is B

Explanation

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